Healthcare Provider Details

I. General information

NPI: 1053408245
Provider Name (Legal Business Name): ESSCO DISCOUNT DRUG CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 E FIFTEENTH ST
YAZOO CITY MS
39194-2706
US

IV. Provider business mailing address

732 E FIFTEENTH ST
YAZOO CITY MS
39194-2706
US

V. Phone/Fax

Practice location:
  • Phone: 662-746-7423
  • Fax: 662-746-8158
Mailing address:
  • Phone: 662-746-7423
  • Fax: 662-746-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01409
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAX SANDERS
Title or Position: PRESIDENT
Credential:
Phone: 662-746-7423